Alysse Einbender, a paraplegic from Wyncote, PA, demonstrates walking with ReWalk.

The growing use of robotic technology in neurorehabilitation promises a brighter future for patients who have residual deficits from their neurological insult. MossRehab is today a center of research and therapeutic use of rehabilitation interventions that make use of robotic devices for patients with stroke and traumatic brain injury.

“The rationale for using robots in rehabilitation is similar to that of industry,” explains Alberto Esquenazi, MD, Chair and Professor, Department of Physical Medicine and Rehabilitation at MossRehab. “Namely, to make repeatable movements very precise with the intention of increasing the intensity of the intervention, aiming to improve the effectiveness of treatment while reducing potential injuries for the therapy staff.”

Robotic devices have a clear edge over manual therapy in their ability to repeat exact movements and avoiding variations due to fatigue, spasm or pain in the patient or fatigue or distraction in the therapist. This consistency appears to be key for effective rehabilitation. As Dr. Esquenazi explains, subconsciously repeatable tasks, like walking, are generated in the spinal cord. Repeating a sequence of precise movements – perhaps thousands of times – may “re-link” this central pattern generator and restore automated function. “The idea is that robotic interventions reduce variability and allow the patient to re-learn the particular task,” says Dr. Esquenazi.

In the Vanguard of Clinical Research and Care

Researchers at MossRehab are actively studying the efficacy and safety of robotic technology in neurorehabilitation. Results from a pilot study in chronic stroke patients with hemiparesis are encouraging.  These patients’ limb pain decreased and their mobility, strength and muscle control improved following robot-assisted repetitions of functional arm movement using the REO^TM. The findings from this study suggest that robotic rehabilitation boosts the performance plateau typically seen in chronic stroke.

“What is most remarkable is that patients who had been impaired the longest had the most improvement,” observes Dr. Esquenazi. “We are encouraged that a patient with long-standing arm dysfunction can respond effectively even long time post-injury.”

MossRehab patient using Lokomat.

The MossRehab Technology Rehabilitation Center is the focal point of several ongoing studies of robot-assisted therapy after neurologic injury. For example, a randomized study is underway comparing robotic-assisted and partial body weight supported treadmill training in patients with traumatic brain injury and residual gait dysfunction using the Lokomat^TM. This study will measure outcomes such as the impact on self selected and maximum walking velocity, walking distance and also help shape future multicenter clinical trials.

Also in progress is an open, non-randomized study of the safety and efficacy of a motorized exoskeleton suit called ReWalk^TM, which enables patients with lower limb paralysis to stand, walk and in some cases climb stairs independently.

Relationship between Research and Clinical Care

The connection between clinical research and clinical care is highly useful when exploring novel approaches such as robot-assisted neurorehabiliation. “We have superb researchers and a clinical crew that is interested in understanding this technology, and they truly bring a unique benefit to the patient population they treat,” notes Dr. Esquenazi. Collaboration among researchers and clinicians is key to early adoption and optimization of robotics in the neurorehabilitation continuum of care.

As this promising technology progresses, Dr. Esquenazi predicts robot-assisted therapy will become integral to stepped care by providing initial high-intensity repeatable treatment followed by traditional manual rehabilitation. Through its use, the researchers and clinicians at MossRehab are in the vanguard of this technology revolution in rehabilitation.